CIRS Protocol: Dr. Mitchell’s Guide to Diagnosing and Treating Chronic Inflammatory Response Syndrome
Dr. Mitchell Explains His 3-Phase CIRS Protocol
From VCS screening and urine mycotoxin testing to binder sequencing and itraconazole – presented at the U.S. Biotek practitioner webinar in April 2026
If you’ve been to doctor after doctor with symptoms no one can explain — crushing fatigue, brain fog, joint pain, anxiety, sensitivity to light — you may have heard the phrase ‘your tests are normal’ more times than you can count.
For many of these patients, the missing diagnosis is CIRS: Chronic Inflammatory Response Syndrome. And in April 2026, Dr. Dean Mitchell, MD presented a comprehensive protocol for evaluating and treating CIRS to practitioners at the US Biotek national webinar series.
This post summarizes everything covered in that presentation — including the diagnostic tools Dr. Mitchell relies on, his stepwise treatment protocol, and real patient cases showing what recovery actually looks like.
What Is CIRS?
CIRS — Chronic Inflammatory Response Syndrome — was first described by Dr. Ritchie Shoemaker in the 1980s and 1990s after he observed fishermen and other patients in the Chesapeake Bay area developing a confusing cluster of symptoms following exposure to biological toxins, including toxic mold.
The term describes a chronic, multi-system inflammatory response triggered by biotoxin exposure — most commonly toxic mold, but also organisms like Lyme disease co-infections and Pfiesteria. The body’s immune system fails to clear these toxins effectively, leading to a cascade of inflammatory effects across multiple organ systems.
As Dr. Mitchell explains: “A lot of doctors have not heard of this. It doesn’t follow a normal track. It’s not like gastroenterology or neurology. This is a whole new field.”
What Are Mycotoxins?
Mycotoxins are toxic compounds produced by mold as a defense mechanism. They enter the body primarily through the respiratory tract — breathing in mold spores — but also through the gastrointestinal system. Once inside, they can persist in tissue for months or years, particularly when exposure continues or when the body’s detoxification capacity is compromised.
Mold can begin growing within 48 to 72 hours of water accumulation in a building. Many patients with CIRS have no idea they’ve been exposed — mold is often hidden behind walls, in HVAC systems, or in basements following flooding.
The 37 Symptoms of CIRS
CIRS is associated with 37 documented symptoms. No patient has all 37, but the breadth of the symptom picture is part of why the diagnosis is so often missed. Key symptoms include:
| Neurological / Cognitive
Chronic fatigue Brain fog / cognitive impairment Memory problems Anxiety and mood changes Sensitivity to bright light EMF sensitivity |
Physical / Systemic
Joint and muscle pain Unexplained weight changes Gastrointestinal symptoms Chronic sinus congestion Skin sensitivity Night sweats / temperature dysregulation |
Dr. Mitchell notes that symptoms like EMF sensitivity and static electricity reactions — which sound unusual — are actually highly specific indicators of mold-related mast cell activation, a condition that frequently co-occurs with CIRS.
How CIRS Is Diagnosed: The 3-Test Protocol
1. The VCS Test (Visual Contrast Sensitivity)
The VCS test is a free or low-cost ($10) online eye test that measures the retina’s ability to detect contrast — not visual acuity. Patients take the test online in about 15 minutes. Abnormalities in columns C, D, and E of the test suggest retinal dysfunction associated with biotoxic illness, including toxic mold and Lyme disease co-infections.
It’s a screening test — not definitive — but it’s a useful, inexpensive first step that can support the clinical picture.
2. Inflammatory Biomarkers
The Shoemaker protocol emphasizes a panel of inflammatory markers including C4a, MMP9, TGF-beta, MSH, and VEGF. Dr. Mitchell used these early in his practice but has largely moved away from them: “I stopped doing it for the most part because I didn’t find that it gave me any additional information… and sometimes some of these tests are not covered by insurance.”
These markers can provide supporting evidence but are not specific to CIRS, and their results don’t change the treatment approach in Dr. Mitchell’s experience.
3. Urine Mycotoxin Testing (Real-Time Laboratories)
This is the cornerstone of Dr. Mitchell’s diagnostic approach — and the test he considers the gold standard. The Real-Time Labs urine mycotoxin panel tests for five major mycotoxin categories:
- Ochratoxin A — associated with Aspergillus and Penicillium molds
- Aflatoxins — Aspergillus molds
- Trichothecenes — includes Stachybotrys (black mold) related compounds
- Gliotoxin — Aspergillus and Candida (note the Candida connection)
- Zearalenone — Fusarium molds
When interpreting results, Dr. Mitchell focuses on two things: (1) how many mycotoxins are present, and (2) how many multiples above the reference range each one sits. Two or more mycotoxins present, especially at 2–3x the upper reference range, is a strong clinical signal.
| Key research: Dr. Joseph Brewer, an infectious disease physician, studied chronic fatigue patients and found that 75% tested positive for mycotoxins on urine testing. This finding transformed how Dr. Mitchell approaches unexplained chronic fatigue cases. |
Dr. Mitchell’s 3-Phase CIRS Treatment Protocol
Phase 1 — Build Resilience
Before beginning detox, the patient’s immune system needs support. Phase 1 focuses on:
- Avoidance — removing the patient from mold exposure (non-negotiable for recovery)
- Sleep optimization
- Hydration — “the solution to pollution is dilution” (Dr. Jill Crista)
- Regular bowel movements — constipation impairs toxin clearance
- IV nutrient therapy — Myers cocktail with high-dose Vitamin C, magnesium, B12, and glutathione
- The anti-mold diet — eliminate sugar, dairy, wheat, alcohol, fermented foods, and leftovers
Phase 2 — Binder Sequencing
This is the core of the detox protocol. Binders are introduced one per week to allow for tolerability assessment:
| Week | Binder | Dose / Brand | Timing |
| Week 1 | Bentonite Clay | 500mg / Metaclay | 2 hours from food |
| Week 2 | Add Activated Charcoal | 250mg / Purecane Supreme | 2 hours from food |
| Week 3 | Add Chlorella | Up to 3 tabs / Pyrinoidosa | 2 hours from food |
| Week 4+ | Add Welchol (Rx) | 1–2 tablets/day | With food |
Welchol (colesevelam) is a prescription cholesterol-binding medication that Dr. Mitchell finds far better tolerated than cholestyramine (often used in the Shoemaker protocol). It is particularly effective against elevated ochratoxin levels. Patients typically stay on Welchol for several months.
Phase 3 — The Fight Phase
Once the patient is resilient and the binders are working, Dr. Mitchell introduces:
- Itraconazole 100mg daily (for at least 1–2 months) — the antifungal of choice for CIRS. Note: fluconazole (Diflucan) is NOT effective for this purpose
- Argentyn 23 nasal spray (hydroxyl silver, OTC) — 1–2 sprays twice daily
- Compounded nasal spray (nystatin + bacitracin + EDTA) — to break up fungal biofilms in the sinus passages
Treating the nasal sinus tissue is critical. The sinuses are a primary reservoir for mycotoxins — patients continue breathing the toxins in even after leaving a mold-contaminated space if sinus treatment is neglected.
Home Mold Evaluation: What to Tell Your Patients
Getting the patient out of mold exposure is the single most important intervention. Dr. Mitchell recommends these assessment options:
- Amunolytics mold plates — inexpensive ($3 each), available online; patients place them in different rooms, leave open for an hour, seal for 5 days, and observe growth. Plates can be sent back to Amunolytics for $36 analysis.
- HERTSMI-2 dust sampling — a validated scoring tool patients can use themselves to assess mold levels
- Professional mold inspection — essential for complex cases or when HVAC systems may be affected
Frequently Asked Questions
Can mycotoxins stay in the body long after moving out of a moldy environment?
Yes. Mycotoxins can persist in tissue for months or years. Dr. Mitchell describes this as the ‘double or triple hit’ scenario: a patient who lived in a toxic mold environment, moved out, and seems to have recovered, may have a reservoir of mycotoxins that become clinically significant when a second stress hits — an infection, a major life stressor, or an immune-depleting event. This is why testing is valuable even when current exposure is uncertain.
Can CIRS cause psychiatric symptoms or be confused with depression and anxiety?
Yes, and it frequently is. CIRS shares symptoms with anxiety, depression, and even PTSD — brain fog, fatigue, mood disruption. Dr. Mitchell approaches this carefully: if a patient has no prior psychiatric history and no clear psychosocial trigger, and there is evidence of mold exposure, the CIRS diagnosis takes precedence. He may collaborate with mental health professionals but treats the mold illness as primary.
Why do some people in the same household get sick while others don’t?
Individual immune variation, particularly HLA genotype, plays a role. Some people are genetically poorer detoxifiers of mycotoxins and will become symptomatic at lower exposures. Dr. Shoemaker’s work has documented specific HLA types associated with increased susceptibility. That said, Dr. Mitchell’s position is that no positive mycotoxin test in someone with confirmed mold exposure should be ignored — even in the asymptomatic patient.
What about probiotics during treatment?
Dr. Mitchell has largely moved away from recommending probiotics for CIRS patients, based on conversations with Dr. Mark Pimentel — one of the world’s leading microbiome researchers — who believes probiotics may actually disrupt gut microbiome diversity. The recommendation instead: eat a high-fiber, low-glycemic diet to support microbiome health naturally.
Watch the Full Webinar
Dr. Mitchell presented this complete protocol to practitioners at the US Biotek national webinar series in April 2026. The recording is available here:
If you’re a patient experiencing unexplained chronic symptoms and would like to consult with Dr. Mitchell, you can book an appointment at mitchellmedicalgroup.com or reach out directly at care@mitchellmedgroup.com.
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ABOUT THE AUTHOR
Dr. Dean Mitchell, MD Board-certified allergist & immunologist NYC & Long Island · 30+ years in practice · Assistant Clinical Professor, Touro College of Osteopathic Medicine · Fellow, AAAAI
Dr. Mitchell is one of the first board-certified allergists in the US to adopt sublingual immunotherapy (allergy drops) and a leading voice in integrative immune medicine. He specializes in Candida overgrowth, MCAS, mold illness, food allergies, and chronic conditions that conventional medicine often overlooks. He has treated patients from all 50 states, in person and via telehealth.
Specialties: Candida & microbiome · MCAS · Mold illness / CIRS · Food allergies · Allergy drops (SLIT)
Featured in: New York Times · Daily Mail · SELF · Martha Stewart · HuffPost · Fox News · ABC · Intelligent Medicine Podcast · Natural Awakenings
Podcast: Host — The Smartest Doctor in the Room · 226+ episodes featuring Harvard, Stanford & NIH researchers · Available on Spotify & Apple Podcasts
Books: Conquering Candida: The New 30-Day Protocol (2025) · Allergy & Asthma Solution (2006)
If you recognize your symptoms in this article
CIRS is treatable — but it requires a physician who knows what to look for and how to confirm it. Dr. Mitchell has helped patients from all 50 states identify and recover from mold illness, often after years of unanswered symptoms and multiple misdiagnoses.
Consultations are available in person at our NYC and Long Island offices, or via telehealth nationwide.
Questions before booking? Reach us at care@mitchellmedgroup.com